The speaker of the United StatesHouse of Representatives is the presiding officer of the United States House of Representatives. The office was established in 1789 by Article I, Section 2 of the U. S. Constitution; the speaker is the political and parliamentary leader of the House of Representatives, is the House's presiding officer, de facto leader of the body's majority party, the institution's administrative head. Speakers perform various other administrative and procedural functions. Given these several roles and responsibilities, the speaker does not preside over debates; that duty is instead delegated to members of the House from the majority party. Neither does the speaker participate in floor debates; the Constitution does not require the speaker to be an incumbentmember of the House of Representatives, although every speaker thus far has been. The speaker is second in the United States presidential line of succession, after the vice president and ahead of the president pro tempore of the Senate.

The current House speaker, Democrat Nancy Pelosi of California, was elected to the office on January 3, 2019. Pelosi served as speaker from January 4, 2007, to January 3, 2011, she has the distinction of being the first woman to serve as speaker, is the first former speaker to be returned to office since Sam Rayburn in 1955. The House elects its speaker at the beginning of a new Congress or when a speaker dies, resigns or is removed from the position intra-term. Since 1839, the House has elected speakers by roll call vote. Traditionally, each party's caucus or conference selects a candidate for the speakership from among its senior leaders prior to the roll call. Representatives are not restricted to voting for the candidate nominated by their party, but do, as the outcome of the election determines which party has the majority and will organize the House; as the Constitution does not explicitly state that the speaker must be an incumbent member of the House, it is permissible for representatives to vote for someone, not a member of the House at the time, non-members have received a few votes in various speaker elections over the past several years.

Every person elected. Representatives that choose to vote for someone other than their party's nominated candidate vote for someone else in their party or vote "present". Anyone who votes for the other party's candidate would face serious consequences, as was the case when Democrat Jim Traficant voted for RepublicanDennis Hastert in 2001. In response, the Democrats stripped him of his seniority and he lost all of his committee posts. To be elected speaker, a candidate must receive an absolute majority of the votes cast, as opposed to an absolute majority of the full membership of the House – presently 218 votes, in a House of 435. There have only been a few instances during the past century where a person received a majority of the votes cast, thus won the election, while failing to obtain a majority of the full membership, it happened most in 2015, when John Boehner was elected with 216 votes. Such a variation in the number of votes necessary to win a given election might arise due to vacancies, absentees, or members being present but not voting.

If no candidate wins a majority of the "votes cast for a person by name" the roll call is repeated until a speaker is elected. Multiple roll calls have been necessary only 14 times since 1789. Upon winning election the new speaker is sworn in by the dean of the United States House of Representatives, the chamber's longest-serving member; the first speaker of the House, Frederick Muhlenberg of Pennsylvania, was elected to office on April 1, 1789, the day the House organized itself at the start of the 1st Congress. He served two non-consecutive terms in the speaker's chair, 1789–1791 and 1793–1795; as the Constitution does not state the duties of the speaker, the speaker’s role has been shaped by traditions and customs that evolved over time. A partisan position from early in its existence, the speakership began to gain power in legislative development under Henry Clay. In contrast to many of his predecessors, Clay participated in several debates, used his influence to procure the passage of measures he supported—for instance, the declaration of the War of 1812, various laws relating to Clay's "American System" economic plan.

Furthermore, when no candidate received an Electoral College majority in the 1824 presidential election causing the president to be elected by the House, Speaker Clay threw his support to John Quincy Adams instead of Andrew Jackson, thereby ensuring Adams' victory. Following Clay's retirement in 1825, the power of the speakership once again began to decline, despite speakership elections becoming bitter; as the Civil War approached, several sectional factions nominated their own candidates making it difficult for any candidate to attain a majority. In 1855 and again in 1859, for example, the contest for speaker lasted for two months before the House achieved a result. During this time, speakers tended to have short tenures. For example, from 1839 to 1863 there were eleven speakers, only one of whom served for more than one term. To date, James K. Polk is the only speaker of the House elected president of the United States. Towards the end of the 19th century, the office of speaker began to develop into a powerful one.

Cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart and treat any stenosis or abnormality found. Most catheterization laboratories are "single plane" facilities, those that have a single X-ray generator source and an x-ray image intensifier for fluoroscopic imaging. Older cath labs used cine film to record the information obtained, but since 2000, most new facilities are digital; the latest digital cath labs use flat panel detectors. Cardiac catheterization laboratories are staffed by a multidisciplinary team; this may include a medical practitioner, cardiac physiologist and nurse. The consultant cardiologist is responsible for gaining arterial access, inserting a sheath into either the radial or femoral artery, passing a wire and catheter into the coronary artery and selectively injecting contrast media into the coronary arteries, they interpret the images taken to ascertain where the narrowed or blocked artery has the problem.

They use a variety of techniques and imaging tools to work the size of things such as balloons and stents. Cardiac physiologists set up what is known as a transducer to monitor pressure in the arteries, they have a live view of the patients ECG so they can tell whether or not there is a problem being caused by the insertion of the catheter into the heart to the electrical pathways. The physiologist will set up a temporary pacemaker if the procedure is an angioplasty or a PCI, they set up defibrillators on to the patient for emergency use if needed. In some locations, some of these responsibilities may be carried out by other personnel, such as trained nurses or technologists. Cardiac catheterization is a general term for a group of procedures that are performed in the cath lab, such as coronary angiography. Once a catheter is in place, it can be used to perform a number of procedures including angioplasty, PCI angiography, transcatheter aortic valve replacement, balloon septostomy, an electrophysiology study or catheter ablation.

Devices such as pacemakers may be fitted. Angioplasty Cardiology Cardiac catheterization

Rayagiri is a panchayat town in Tirunelveli district in the Indian state of Tamil Nadu As of 2001 India census, Rayagiri had a population 10,855. Males constitute 52% of the population and females 48%. Rayagiri has an average literacy rate of 61%, higher than the national average of 59.5%: male literacy is 72% and female literacy is 50%. In Rayagiri, 11% of the population is under 6 years of age. Rayagiri is 121 km from Madurai towards south and 86 km from Tirunelveli towards north and 3 km away from Madurai - chengottai Highway; the nearest cities to Rayagiri are Rajapalayam and Sankaran Kovil. In Rayagiri, there are six elementary schools, one girls high school, one higher secondary school and two private matriculation schools are available. There are Rayagiri HinduNadar Uravinmurai thiru Si. Ba Sivanthi Aathithanar Higher secondary school, Rayagiri Hindu Nadar Uravinmurai thiru Si. Ba Aathithanar girls High school, Rayagiri Hindu Nadar Uravinmurai thiru si ba Aathithanar primary school, Rayagiri Hindu Nadar Uravinmurai thiru Ramasamy Nadar primary school, Rayagiri Hindu Nadar Uravinmurai thiru Kamarajar primary and Matriculation school, Arunachala duvakkappalli and Kumutha Nursary school Swamiyae Saranam Ayyappa...